As we move into 2019, home care in Ireland is facing some significant issues. Ever increasing demand in the face of limited budgets and huge difficulties in the recruitment and retention of carers, mean the future for the sector will be challenging.
However, it doesn’t have to be all doom and gloom. There are actions the sector can take to meet and overcome these obstacles but it will take radical and bold steps if we are to do so.
Technology is perhaps the main hope to revolutionise the sector. Could 2019 be the year when advances in AI, big data and the Internet Of Things (IOT) finally make a significant impact? We need technology to scale and embed itself in the sector so that our scarce resources are used in a more efficient manner. We also need technology to be more user friendly for older and disabled people and advances in the area of voice technology will help hugely here. As this happens, we will begin to pre-empt conditions and events, allowing them to be acted on much earlier thereby avoiding admissions to acute settings.
As wearable devices and in-home technology become more mainstream, it will mean a better, more efficent utilisation of the care workforce.
By harnessing technology, we can also equip carers with more tools to do their job, give them better professional development and career pathways to achieve strong carer retention.
To date home care has been commissioned through tenders every 3 to 4 years with the focus being on price per hour of care with little regard for outcomes. This approach does little to drive quality or deliver for the service user. A movement towards outcome based commissioning would encourage providers to provide the type of care and support service users really need and enable them to grow their services in line with their client’s needs including clinical type care at home.
For outcome based commissioning to become a reality, more work is needed in defining outcomes and then measuring them. A movement in this direction will ensure better more efficient use of funds.
In addition, commissioning needs to promote more logical geographical care provision, by avoiding situations where 2 or 3 different providers are providing care on the same road with different sets of carers.
New Ways of Working
At the moment anyone who is gets a home care package has to select from a list of approved corporate providers who give a full agency service whether the family need it or not. This shoehorning of families into one type of care delivery, means that in situations where the person themselves or family members are in a position to manage their own care delivery, a significant portion of their package can go on unnecessary agency administration and supervisory costs. Surely families where appropriate, should be able to opt out of this type of arrangement and for example contract directly with local qualified carers. This would mean they could get more hours of care for their funding and perhaps more importantly, more funding would flow directly into carers pockets, making caring a more attractive career and also driving quality through incentivising carers.
This type of provision could also make inroads into the significant amount of undeclared care work that goes on, as there would be less incentive to pay in cash.
Presently we have a declining pool of carers available and this decline has been exaggerated as the economy has improved and carers find more attractive employment options in other sectors. In addition the existing cohort of carers are courted by all the various providers, often working with more than one provider at a time and as such they are used very inefficiently.
The sector needs to do more to attract new populations into the caregiving workforce and target people who may not have considered working as carers previously. These people could be reached through better and more extensive social media campaigns. We need to look at both ends of the age scale, young students as well as older people maybe close to or at retirement age. What about the state offering the retired or unemployed extra benefits if they did a certain number of hours care each week or students getting help with their fees in exchange for doing care work?
Home care is unique in the access it gives providers to patients. Often carers attend clients 3 to 4 times a day. This unparalleled access needs to be better utilised by health sector stakeholders including the acute sector, G.P.s, insurance companies and the pharma sector. Partnerships with these stakeholders will develop in the near future to the benefit of patients and government budgets.
In 2019 we need to be more ambitious with regard the role home care can play in our health sector. Yes we face challenges but none that can’t be surmounted by the mainstream incorporation of technology, innovative thinking and being open to alliances and wider co-operation.